Provider Demographics
NPI:1427133586
Name:AGARWALA, ATUL KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:ATUL
Middle Name:KUMAR
Last Name:AGARWALA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1308 CENTENNIAL AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854
Mailing Address - Country:US
Mailing Address - Phone:908-222-3506
Mailing Address - Fax:908-222-8770
Practice Address - Street 1:40 UNION AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111
Practice Address - Country:US
Practice Address - Phone:973-399-6270
Practice Address - Fax:973-374-3346
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
NJMA61586207W00000X
NY207R00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6875700Medicaid
NJMA06158600OtherNJ MEDICAL LICENSE
NY1900871OtherNY STATE MEDICAL LICENSE
NJD-06711300OtherCDS NUMBER
NJ10456275OtherCAQH
NJ1427133586OtherNPI
NJBA6317297OtherDEA
NJMA06158600OtherNJ MEDICAL LICENSE
NJBA6317297OtherDEA